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Multiple social media posts claim that prolonged wearing of face mask cause hypoxia, oxygen deficiency in the body and fatigue. The post doesn’t mention the type of mask (N95, Surgical, HomeMade etc.). We evaluated the claim from multiple perspective and found it to be Mostly True.
NOTE: Some fact checking platforms (India Today ; Snopes) have rated this claim as “Mostly False” with the caveat that people should wear right fitted, surgical or cloth made masks. We believe, the issue needs a deeper look keeping in mind your age, medical condition and type of mask you are using (especially in India where home-made masks are popular)
The claim can be traced back to an article published in Nigeria based media platform Vanguard. (Source). It is been credited to ‘Dr Dennis A Castro B’.
The same post has been copy pasted and circulated on facebook and social media by multiple users. Archived link of one such post is here and snapshot of many such multiple posts are below:
We tried tracing Dr Dennis A Castro B but couldn’t. We reached out to the publication house asking them to connect us to Dr. Dennis for further clarification on the issue, but we have not heard back from them yet.
In the meantime, we did our own investigation on the topic based on published research and expert opinion.
What is Hypoxia?
Hypoxia is a condition in which there is an absence of enough oxygen in the body or a region of the body at the tissue level.
Can prolonged usage of masks cause Hypoxia?
There is a split verdict on this. But most of the experts we talked to says, it’s possible.
Various researches at various points of time have revealed that prolonged usage of masks can reduce intake of oxygen.
As per an old research published in Researchgate.com (Source), a survey was conducted among healthcare workers for whom wearing N95 face masks was mandatory during the 2003 severe acute respiratory distress syndrome epidemic. Over 37% percent of the surveyed candidates complained of headaches.
Commenting on a story in Scroll.in in 2017, in the context of wearing masks for long durations to escape from air pollution, Dr D Saha, scientist and additional director at the Central Pollution Control Board, said, “(Masks) can lead to oxygen shortage, suffocation, respiration trouble, and heart attacks” (Source).
In a recent news published on the website of Stanford (Source), John Xu, a research scientist at Stanford created ‘a new type of protective face mask that extracts and concentrates oxygen from the air to avoid the considerable side effects of oxygen deficiency while preventing the spread of the virus’. Explaining the need of the new invention, Xu explained, “N95 masks are estimated to reduce oxygen intake by anywhere from 5 to 20 percent. That’s significant, even for a healthy person. It can cause dizziness and light headedness. If you wear a mask long enough, it can damage the lungs. For a patient in respiratory distress, it can even be life threatening.”
However, a few experts believe masks do not cause any trouble in oxygen intake. But most these experts also put in a condition attached to it. In the fact check done on the same topic by India Today, Dr Sanjeev Bagai, chairman of Nephron Clinic, mentions masks will not cause suffocation if they are “… of appropriate size and shape. It should not be so tight on your face that it makes you feel uncomfortable.”
While India Today puts focus on the ‘right size’, Fact Checking of Snopes on the same topic emphasizes on the right material. Snopes put the caveat as ‘people wearing cloth or surgical masks are in little to no danger of breathing in unhealthy amounts of carbon dioxide.’
The WHO website has given a recent guidelines on masks. The guideline reads, “The prolonged use of medical masks can be uncomfortable. However, it does not lead to CO2 intoxication nor oxygen deficiency. While wearing a medical mask, make sure it fits properly and that it is tight enough to allow you to breathe normally. Do not re-use a disposable mask and always change it as soon as it gets damp.” It needs to be noted that the guideline clearly mentions medical masks (also sold as surgical masks in many Indian shops) and also talks about the proper fitting.
NOTE: The particular article on Vanguard or the facebook posts do not talk about mask type, material or size. The advisory was against wearing masks in general for prolonged period of time.
We asked Dr.Sai Praveen Haranath, Intensivist and Pulmonologist, Apollo Hospitals, Hyderabad. He says, “Depending on the correct fit and the type of mask there will be resistance to air movement. If in an isolated area with low risk of exposure or risk of exposing others to infection can remove the mask. Masks can lead to difficulty in breathing and sometimes can affect the exchange of gases causing a rise in carbon dioxide and a drop in oxygen level. Using the correct mask based on the exposure risk will be the right choice.”
What if the masks are made of wrong material or is of wrong size? Can it lead to suffocation?
It is evident that wrong sized masks or masks made from wrong materials can lead to suffocation. According to Dr. Smarajit Maiti, Consultant Paediatrician and Neonatologist, Bhagirathi Neotia Woman and Child Care Centre, Kolkata, “Hypoxia due to masks is not an uncommon thing. It is always recommended to use a mask which is well fitted and is provided with a respiratory valve.”
As per the guidance on wearing masks on the Henry Ford website (Source), “Do not use paper or plastic bags, scouring pads or sponges as masks. These things won’t give you the protection you need, and in the case of plastic bags, they could lead to suffocation and death.”
What about people with Asthma, High Blood Pressure or any other respiratory disease? Can they face breathing problems due to prolong usage of masks?
Dr. Sanjeev Jain, Consultant – Pulmonologist, Fortis Hospital, Delhi, says, “Persons with pre existing respiratory problems should also wear the mask same way. However, since prolonged wearing of mask has a chance to cause hypoxia, intermittent fresh air should be taken as advised.”
What about babies or children? Can they face Hypoxia due to prolonged usage of masks?
Dr. Smarajit Maiti (Paediatrician) mentions, “Masks without respiratory valve is not advisable for children. If an adult can fall prey to Hypoxia due to mask, a child can too. It is necessary to ensure you are buying a mask with well ventilation facility for your child. As for babies, masks are not a feasible option. It can lead to dangerous situation like suffocation if goes unnoticed. Rather, hygiene and proper protection of the care givers, maintenance of cough protocol and off course awareness may be helpful.”
Should you take off your masks after every 10 minutes to get some fresh air?
Dr. Jain (Pulmonologist) agrees, “Any mask that a person wears should be used as a barrier and not as a sealant. It should allow intermittent passage of fresh air. Only in areas where there are high chances of getting a possible infection, it is advisable to wear a more sealing mask. If possible mask should be removed intermittently and fresh air should be inhaled.
Dr. Joyeeta Chowdhury, MD. Assistant professor, Dermatology, NRS Medical College and Hospital adds to the same, “It is natural to feel suffocated after 10-15 mins of wearing a mask, afterall not all of us are wearing scientifically designed well ventilated masks. You need to readjust the mask at that time or breathe in fresh air. But the most critical thing to remember is to clean or sanitize your hands while touching the mask. Also, while adjusting don’t flip the outside surface inwards.”
Expert Advisories on Mask Usage
Dr. Jain (Pulmonologist) says, “Masks are required only when you are in a crowded place”
The WHO guidelines also read the same. On their website WHO mentions, “If you are healthy, you only need to wear a mask if you are taking care of a person with COVID-19. Wear a mask if you are coughing or sneezing. Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.”
Dr. Smarajit Maiti (Paediatrician) says, “Schools are high risk zones. You cannot expect a child to always maintain social distancing properly. Ideally, a child should enter the school wearing a mask and not take it off before they come back home. In between, they should not take the mask off with unclean hands or touch the insides of the mask. However, it’s a bit difficult to ensure all the rules are followed when you are dealing with children. So, ensure you provide them a mask with a respiratory valve. This will lessen the chance of suffocation or hypoxia.”
Dr. Sanjeev Jain (Pulmonologist) says, “It needs to be emphasized that the new Coronavirus is not an air borne pathogen. Apart from surface touch, it only transmits through close physical or breathing contact. So, a mask is only required is crowded areas. There is no reason to wear a mask while driving a car”
Dr. Joyeeta Chowdhury (Dermatologist) says, “Masks are now being sold in footpaths. These are majorly cloth masks and they need to be cleaned and sterilized properly before use. There should not be issues with skin if you maintain a proper hygine of your mask. If you are using surgical masks, learn to discard them properly by cutting them in between so that they are not picked up and recycled.”
Dr. Chowdhury says, “Sometimes colour from dyed masks may cause irritant contact dermatitis or even contact urticaria. But this remains to be established as we have only heard of a couple of isolated cases like these so far”
Dr. Rachna Khanna Singh, Director, The Mind and Wellness Studio says, “Initially there can be a sense of confinement but that should go away as we condition our mind and start accepting this as a new normal. Children should be taught this as a habit as common as wearing clothes.”
Dr. Singh adds, “Even if someone feels a bit restricted due to wearing mask, it should not be as severe as feeling suffocated. Gradually this feeling of restriction should go away as you get used to wearing a mask.”
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